A Four-Arm Study Comparing the Analgesic Efficacy and Safety of Tramadol Once a Day 100, 200 and 300 mg Versus Placebo for the Treatment of Pain Due to Osteoarthritis of the Knee (With 7-Day Follow-up)

The objective of this study is to compare the analgesic efficacy and safety of Tramadol Once a Day 100, 200, 300 mg and Placebo

Study Overview

• Status: Completed
• Conditions: Pain
• Intervention / Treatment: Drug: Tramadol Once A Day; Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 552
• Phase: Phase 3

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Males or Females between the ages of 40-75 with a diagnosis of moderate to severe osteoarthritis of the knee, consistent with the ACR Clinical Classification Criteria for Arthritis of the Knee:

   • Current knee pain.
   • Less than 30 minutes of morning stiffness with or without crepitus on active motion.
   • Confirmation either by arthroscopy or radiologist's report (X-rays showing osteophytes, joint space narrowing or subchondral bone sclerosis {eburnation}) within five years prior to entry into the study.
2. CRP < 8 ug/mL (if available at local lab) or ESR < 40 mm/hr.
3. Total WOMAC (Western Ontario and McMaster University Osteoarthritis Index) Pain Subscale Score of > 150 mm at Baseline corresponding with moderate to severe Osteoarthritis.
4. Oral and written language comprehension at a level sufficient to comply with the protocol and complete study-related materials.
5. REB approval of the written Informed Consent Form in Spanish or English which was signed and dated by the patient and Investigator, prior to study participation.

Exclusion Criteria:

1. Known rheumatoid arthritis or any other rheumatoid disease.
2. Secondary arthritis i.e. any of the following: septic arthritis; inflammatory joint disease; gout; pseudogout; Paget's disease; joint fracture; acromegaly; fibromyalgia; Wilson's disease; ochronosis; haemochromatosis; osteochondromatosis; or collagen gene mutations.
3. Evidence of effusion greater than 15 cc upon physical examination of the joint at Baseline (Visit 1).
4. BMI greater than or equal to 38.
5. Major illness, requiring hospitalization during the 3 months before commencement of the screening period.
6. Unwillingness to stop taking pain medication (for arthritis or other types of pain) or was unwilling to stop taking other medications for the treatment of OA.
7. Previous failure or discontinuation (due to adverse events) of tramadol HCl therapy.
8. Treatment within the last 3 weeks with any of the following medications: monoamine oxidase inhibitors; tricyclic antidepressants and other tricyclic compounds (e.g. cyclobenzaprine, promethazine); neuroleptics; selective serotonin reuptake inhibitors; or any other drug that reduces seizure threshold.
9. Treatment with another investigational agent within the last 30 days.
10. A history of seizure disorder other than Infantile Febrile Seizures.
11. Previous or current opioid dependency.
12. Bowel disease causing malabsorption.
13. Pregnancy or lactating or childbearing potential and unwilling to utilize a medically approved method of contraception during participation in this clinical trial.
14. Significant liver disease, defined as active hepatitis or elevated liver enzymes >3 times the upper boundary of the normal range.
15. Significant renal disease, defined as creatinine clearance <30 mL/min as estimated by the method of Levey et al., 1999.
16. Current substance abuse or dependence, other than nicotine.
17. Allergy or adverse reaction to tramadol or any structurally similar drugs e.g. opiates.
18. Any other condition that, in the opinion of the Investigators, would have adversely affected the patient's ability to complete the study or its measures.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1: Tramadol Once A Day 100mg	Drug: Tramadol Once A Day; One Tramadol Once A Day tablet at randomized dose daily.
Experimental: 2: Tramadol Once A Day 200mg	Drug: Tramadol Once A Day; One Tramadol Once A Day tablet at randomized dose daily.
Experimental: 3: Tramadol Once A Day 300mg	Drug: Tramadol Once A Day; One Tramadol Once A Day tablet at randomized dose daily.
Placebo Comparator: 4: Placebo	Drug: Placebo; One Placebo tablet daily.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Global Rating of Pain for the Study Period (12 Weeks)	3-item Likert-scale: "How do you rate overall pain relief with the drug?" with 3 possible answers: "very effective", "effective", or "ineffective". The average of ratings at visits 2-5 was calculated as median, rounded up to the closest integer.	12 weeks
Percentage Difference Between WOMAC Pain Subscale Score From Baseline to the End of the Study (Week 12)	Percentage of difference in WOMAC Pain Subscale score between baseline and week 12. The WOMAC scale is a 24-item questionnaire divided in 3 subscales, using a 100mm visual analog scale (VAS) ranging from no pain (0mm) to extreme pain (100mm). The WOMAC Pain Subscale results from the sum of 5 of the questions.	12 weeks
Percentage Difference Between WOMAC Physical Function Subscale Score From Baseline to the End of the Study (Week 12)	Percentage of difference in WOMAC Physical Function Subscale score between baseline and week 12. The WOMAC scale is a 24-item questionnaire divided in 3 subscales, using a 100mm visual analog scale ranging from no difficulty (0mm) to extreme difficulty (100mm). The WOMAC Physical Function subscale results from the sum of 17 of the questions.	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change in WOMAC Pain Subscale Score From Baseline to Intervening Visits (Visits 2-4)	Percentage of difference in WOMAC Pain Subscale score between baseline and intervening visits 2-4. The WOMAC scale is a 24-item questionnaire divided in 3 subscales, using a 100mm visual analog scale ranging from no pain (0mm) to extreme pain (100mm). The WOMAC Pain Subscale results from the sum of 5 questions.	Week 0, week 3, week 6
Percentage Change in WOMAC Physical Function Subscale Score From Baseline to Intervening Visits (Visits 2-4)	Percentage of difference in WOMAC Physical Function Subscale score between baseline and intervening visits 2-4. The WOMAC scale is a 24-item questionnaire divided in 3 subscales. The WOMAC Physical Function Subscale comprises 17 questions each rated on a 100mm visual analog scale (VAS) ranging from no difficulty (0mm) to extreme difficulty (100mm).	Week 0, week 3, week 6
Multiple Dose Effect Using 24-hour VAS Pain Questionnaire	Patients rated their knee pain by marking a 100mm Visual Analogue Scale, ranging from no pain (0mm) to extreme pain (100mm).	12 weeks
Investigator Global Rating of Pain Relief	The Investigator Global Rating of Pain is a 3-item Likert-scale to answer the following question: "How do you rate this patient's overall pain relief with the drug?" with 3 possible answers: "very effective", "effective", or "ineffective".	12 weeks
Dropout Rate	Reasons for withdrawal from the trial were collected	12 weeks

Collaborators and Investigators

• Sponsor: Labopharm Inc.

Publications and helpful links

General Publications

• Fishman RL, Kistler CJ, Ellerbusch MT, Aparicio RT, Swami SS, Shirley ME, Jain AK, Fortier L, Robertson S, Bouchard S. Efficacy and safety of 12 weeks of osteoarthritic pain therapy with once-daily tramadol (Tramadol Contramid OAD). J Opioid Manag. 2007 Sep-Oct;3(5):273-80. doi: 10.5055/jom.2007.0015.

Helpful Links

• Approved labelling

Study record dates

Study Major Dates

• Study Start: January 1, 2003
• Primary Completion (Actual): August 1, 2003

Study Registration Dates

• First Submitted: January 29, 2009
• First Submitted That Met QC Criteria: February 26, 2009
• First Posted (Estimate): February 27, 2009

Study Record Updates

• Last Update Posted (Estimate): April 30, 2012
• Last Update Submitted That Met QC Criteria: April 25, 2012
• Last Verified: April 1, 2012

More Information

Terms related to this study

• Keywords: Pain due to Osteoarthritis of the Knee
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee; Physiological Effects of Drugs; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Analgesics, Opioid; Narcotics; Tramadol
• Other Study ID Numbers: MDT3-003; NCT00852917 (Registry Identifier: ClinicalTrials.gov)